Dr. Greg Jorgensen
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Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

What Is a Frenectomy and When Is It Necessary?

Posted by Dr. Jorgensen on June 1st, 2011

 

customer service represenatative beautiful smiling on phoneOrthodontic treatment involves more than just putting braces on your teeth. The teeth are just one part of your smile. Sometimes your orthodontist will recommend other procedures to help make your results the best possible. One such procedure is a frenectomy.

Successful orthodontic treatment creates a smile that is attractive, healthy, and stable. Achieving a stable result requires that your orthodontist consider the size and shape of the teeth, the position of the teeth in the bone, the pressure from the lips and tongue, and the condition of the surrounding soft tissues. Thick gums can affect the position of the teeth before, during, and after treatment. One of the most common conditions related to the gum tissues is a space created by a thick band of tissue lying between the upper front teeth known as the “frenum.” The procedure used to remove this tissue is known as a “frenectomy.”

You will find the frenum connecting the inside of the upper lip to the gum tissue between the roots of the upper front teeth. Normally the frenum blends into the gum tissue well above the level of the teeth. In some cases however, it extends between the front ones and appears to push them apart creating a space. In most cases however, the frenum was present when the permanent incisors came into the mouth forcing them to come in spread apart. Not only can this tissue prevent the front teeth from coming into the mouth next to each other, it can also push them apart after orthodontic treatment. Dentists perform frenectomies to keep this from happening.

There is some controversy about the best time to remove this tissue. Sadly, merely clipping the frenum after the permanent incisors have come in will not make them to go back together on their own. A “standalone” frenectomy is only effective at closing a space if it is performed before the teeth have come in (making it essentially a preventive measure). If your dentist or orthodontist notices that your child’s frenum is too long before the permanent teeth poke through, removing the extra tissue may allow them come in next to each other.

If there is already a space between the teeth, the best time to do the frenectomy is after your orthodontist has closed the space with braces. This is most effective for two reasons. First, if the teeth are brought together and the frenum reevaluated, it may be discovered that the tissue is not actually pushing the teeth apart at all and that the procedure may not be necessary. Second, if a frenectomy is deemed necessary after the space is closed, it is best to have the teeth in their desired positions while the tissue is healing. Scar tissue that forms between the teeth as a result of the surgery might actually make the space harder to close during treatment and force the teeth back apart afterwards. Therefore the best time to do a frenectomy is after the space has been closed.

One added precaution that should be taken after closing a space and performing a frenectomy is stabilizing the incisors with a bonded retainer for at least a year. This not only holds the space closed in the short-term, but it also gives the bone and gums around the teeth a chance to adapt to their new position so they’ll be more stable in the long-term.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

What Is a Frenectomy and When Is It Necessary?

183 comments so far in response to “What Is a Frenectomy and When Is It Necessary?”

  1. Michelle says:

    My son Is 6 and has lost his 2 top front teeth. One tooth has come in, the other is not in yet. We were recently at the dentist and he suggested doing a frenectomy on my son because he says the frenum is thick which will create a gap between his teeth. He does have crowding issues, 2 6 yr. molars are hung up on his existing teeth, those teeth will also be extracted during this procedure so the 6yr. molars can come in. A frenectomy is new to me, my dad has a gap in his teeth and has lived with it his whole life. This dentists concern is the crowding, he said the frenectomy may give my son much needed space for the lat. incisors to drop in place. I’d like an opinion on this as well. I have my son’s xrays, they look awful to me but I’m not a dentist. Obviously. Any input is welcome.

    • If your son really has a thick frenum, it could create a space. That space will steal room needed for the bigger teeth trying to come in. I agree with your dentist’s explanation.

      • Michelle says:

        Thanks so much, I appreciate your input. We were just so worried about having something done, and either it not being the right procedure, or not being a necessary procedure. Thanks for replying!

  2. Rachel T says:

    I recently took my son to consult with an oral surgeon about a frenectomy. He is 6 years old and has both his adult front teeth in. There is a gap and the dentist has suggested a frenectomy now. He didn’t seem concerned about crowding and my son is not in pain. Could it be purely for cosmetic reasons or will it be beneficial and reduce the chance that he’ll need braces in the future. He really does not have any other dental issues at the moment.

    • If your son’s frenum is too large, it will prevent the front teeth from coming together. This will “steal” space from the lateral incisors and they won’t have the room they need. If your dentist has determined a frenectomy would be beneficial, I would advise you to proceed. It won’t hurt anything and my be very necessary in the normal development of his smile.

  3. Lavonne Morrill says:

    I had a frenectomy a few days ago when I had my 6 front teeth fitted for crowns (I am currently wearing a “temporary” set of 6 connected teeth). My dentist said that my frenum and shifted with my gums (?) and that it was pulling my lip off center. I had noticed it a little bit. So, my dentist recommended a frenectomy, so that my lip will drape evenly over my new teeth. What I have noticed (well, it’s only been 2 days) is that my smile looks different. Is this common or am I just imagining things?

    • You’ve had a lot of work done on your teeth, gums, and lip. I would wait until your final crowns are in place and the tissue has healed before worrying. I have not noticed permanent changes in the lip after a frenectomy.

  4. angie says:

    Hi I have a year that i gotten braces since I had a gap in between my top front teeth they are closing now but I have extra tissue in between an was wondering is a frenectomy better to do while I still have braces or after my braces have been removed??

    • If the space is closed all the way, it really doesn’t make a difference when it is done. What is critical is that the gap be held closed for some time after the braces come off because they tend to reopen immediately afterwards.

  5. Aimee Blubaugh says:

    Hello, I am 20 years old and the dentist I am currently seeing is recommending that I get a frenectomy. This is strange to me because when I was a child and teenager I went to a pediatric dentists and orthodontics, had braces, and there was not one single mention that my frenum was a problem. Wondering if it’s as “necessary” right now as my dentist is making it out to be? My gums are tender, but I wouldn’t say that it is leaving me with terrible pain either. Any advice on what I should think is greatly appreciated!

    • It depends upon why he is recommending the frenectomy. If it is related to a problem with the attachment of your gums (called a frenum pull), it is plausible that you could need it at age 20.

  6. Alanah says:

    Hi, I have a 4 year old and she has a large frenum which is creating a gap between her top front baby teeth. She is now being referred to a dental surgeon to get another opinion and it will possible be removed. Is it best to have the frenum removed now while she still has her baby teeth? By removing it now, will it allow her permanent teeth to come in closer together?

  7. Betty says:

    Hello Dr. Jorgensen,

    My 7 year old has a mesioden near his two front teeth. while the incisors (central and lateral) on the left side of his mouth have come into place the right side incisors have not (and are at the same angle. his doctor has said that we need to remove the mesioden because it is “in the way” and the reason why the teeth have not gotten into place. BUT the doctor also suggest we do a frenectomy. My son doesn’t seem to have a gap and while the problematic incisors are not in place they do meet at the top. In other words –no gap. I don’t the frenectomy is necessary but I am not a dentist 🙂 What do you suggest?

    • I had a mesiodens that had to be removed so my teeth could come in. I cannot diagnose the need for the frenectomy from here, but I would ask the doctor to explain why it is necessary at this time.

  8. Tina says:

    My daughter is 13 years old, she has a gap between her teeth and she needs braces, the braces will close her gap. But I went to the orthodontist referred to us by our dentist and he is saying she needs a frenectomy before braces. I looked online and one doctor blog said that If she gets it before braces the gap would never close because of scar tissue. please help any advise please!! – Tina

    • I know doctors who do it both ways. I prefer to wait, but I’ve seen successful results in children who’ve been treated the other way too. I like to let the healing occur AFTER the teeth are in their new position. That makes sense to me.

  9. Leah says:

    Hi,
    I am a 20 year old. I have already had braces. Before braces, I had a gap between my front teeth and my frenum came all the way down to the middle of my teeth. Now its still there squeezed between my teeth. Is it possible that this can make my teeth shift? I wear retainers but my bottom teeth already shifted and I am a little apprehensive because I really don’t want to pay for round 2 of orthodontia!

    Thanks!

    • This sounds like a perfect case for a frenectomy. The tissue between your teeth is elastic and it can push the teeth apart after the braces are removed. I would definitely discuss this with your orthodontist BEFORE your braces are removed.

  10. Maureen says:

    I wore braces in my late teens and my diastema was closed, I used a temporary retainer and it was later changed to a fixed retainer, which got knocked off about 3 years after I started using it, and the diastema opened almost immediately, before I could go back to my orthodontist. After awhile, he suggested I use braces to close it again. The diastema closed and I had a frenectomy done. The arch wire was removed for the procedure with the intention of fixing it right after the procedure was completed, but I wasn’t feeling too good afterwards, so I returned a few days later to have the arch wire but back. I noticed in this short period that the diastema opened up a little. Will this affect the healing process? I thought the diastema will remain close after the frenectomy. Thanks.

    • A few days should not have been an issue at all. I would not worry. Remember that ever after a frenectomy, the only sure way to keep a diastema closed is with permanent retention.

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